POS0651 IMPACT OF ADVERSE DRUG REACTIONS ON THE TREATMENT PATHWAYS OF EARLY RHEUMATOID ARTHRITIS PATIENTS
Authors: F. Poppelaars, J. Jansen, P. Ten Klooster, T. Coppes, K. Velthuis, H. Vonkeman, N. Jessurun
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) patients frequently pass through several medications in order to achieve and maintain acceptable disease control The clinical heterogeneity and variable course of the disease, plus the availability of multiple classes and subclasses of DMARDs may lead to very different and complex treatment sequencing in individual patients. Limited real-world data exists regarding treatment pathways among patients with RA. Adverse drug reactions (ADRs) belong to the stop reasons of medication, but the impact of ADRs on treatment pathways has not been quantified. Objectives To assess differences in treatment pathways between RA patients with and without adverse drug reactions (ADRs). Methods Single center retrospective observational study, using real-world data collected in the Dutch Rheumatoid Arthritis Monitoring (DREAM-RA) registry from Medisch Spectrum Twente (Enschede, the Netherlands). From all early RA patients enrolled between 16 July 2006 and 30 April 2020, the first four consecutive courses of treatment were assessed. Patients were selected from the DREAM early RA treat-to-target cohort I. 1 The use of corticosteroids per protocol was allowed but not considered as a DMARD treatment. Any alteration in (a combination of) medication was viewed as a separate treatment, and thus any addition, subtraction or change in medication was the start of a new treatment. If a patient was without continuous treatment for 90 days or more in between treatments, this was considered a temporary stop of treatment. Treatment pathways were stratified for occurrence of at least one ‘ADR or ‘No ADR’. Differences in duration of treatment, number of treatments, and the proportion of treatments with csDMARDs, bDMARDs and a combination of csDMARDs and bDMARDs between patients with and without ADRs are assessed. Results Treatment pathways of 372 RA patients (66.1% females) were assessed (Table 1). The average duration of treatment was shorter in patients that experienced at least one ADR (1.8 vs. 2.7 years, p&lt;0.001), and the number of treatments was higher (3.5 vs. 2.5, p&lt;0.001), than in those that experienced no ADR. Furthermore, there was a difference between these groups in the proportion of treatments with csDMARD(s), bDMARD(s) or a combination of the two (p&lt;0.001). This was for the ‘No ADR’ group respectively 93%; 1%; 6%, and for the ‘ADR’ group respectively: 77%; 8%; 15%. Table 1. Characteristics of patient with and without adverse drug reactions (ADRs) and treatment pathways All patients Females Males Patients without ADRs Patients with ADRs Total, n (% of all patients ) 372 (100.0) 246 (66.1) 126 (33.8) 285 (76.6) 87 (23.3) Female, n (% of total ) 246 (66.1) N/A N/A 183 (64.2) 63 (72.4) Age at start of treatment in years, mean ±SD 57.8 ±14.0 57.3 ±14.3 59.0 ±13.2 58.4 ±14.4 56.0 ±12.3 Follow-up time in years, mean ±SD 6.7 ±3.7 6.8 ±3.6 6.6 ±3.9 6.9 ±3.8 6.2 ±3.4 Duration per treatment in years, mean ±SD 2.4 ±2.9 2.4 ±2.8 2.4 ±2.9 2.7 ±3.0 1.8 ±2.2* Distribution of treatments: 1 113 (30.4) 72 (29.3) 41 (32.5) 104 (36.5) 8 (9.2) 2 25 (6.7) 18 (7.3) 7 (5.6) 20 (7.0) 5 (5.8) number of patients that received 1, 2, 3 or 4 treatments, n (% ) 3 83 (22.3) 53 (21.5) 30 (23.8) 70 (24.6) 13 (14.9)* 4 or more 151 (40.6) 103 (41.9) 48 (38.0) 91 (31.9) 61 (70.1) Number of treatments, mean ±SD 2.7 ±1.3 2.8 ±1.3 2.7 ±1.3 2.5 ±1.3 3.5 ±1.0* Number of patients stopped with treatment, n (% of total ) 84 (22.6) 56 (22.8) 28 (22.2) 71 (24.9) 18 (20.7) * p&lt;0.001 Conclusion Treatment pathways for patients with and without ADRs differ significantly. Patients that experience ADRs have shorter duration of treatments and have more consecutive treatments utilizing more bDMARDs. References [1]Steunebrink LM, Versteeg GA, Vonkeman HE, et al. Initial combination therapy versus step-up therapy in treatment to the target of remission in daily clinical practice in early rheumatoid arthritis patients: results from the DREAM registry. Arthritis Res Ther 2016;18:60. Disclosure of Interests Fenna Poppelaars: None declared, Jurriaan Jansen: None declared, Peter ten Klooster: None declared, Tristan Coppes: None declared, Kimberly Velthuis: None declared, Harald Vonkeman Speakers bureau: Amgen, BMS, Celgene, Galapagos, GSK, Janssen-Cilag, Lilly, Novartis, Pfizer, Roche, Sanofi-Genzyme, UCB, Grant/research support from: Abbvie, Sanofi-Genzyme, Naomi Jessurun: None declared